engaging-the-family-in-recovery-outcomes-of-a-communitybased-family-intervention.pdf

Copyright @ 2019 psyChologiCal assoCiation of the philippines
The Katatagan Kontra Droga para sa Komunidad (KKDK) is a Filipi-
no community-based drug recovery program that addresses individual
and family issues. This study explores the changes in the family after
the drug users completed the program. Surveys and interviews were
used to evaluate changes in family support, quality of family life, and
substance use disorder (SUD) symptoms. Results show participants
perceived significant increase in family support and quality of family
life, as well as decrease in SUD symptoms. Their family members also
reported individual and familial changes in the participants as a result
of the program. They showed remorse, became more responsible, and
communicated better after going through the intervention. There was
also an improvement in quality of family life, religious rituals, and time
spent with the family. Implications on community-based drug recovery
programs focusing on family changes are discussed.
Keywords: family, community, drug recovery program
philippine Journal of psyChology, 2019, 52(1), 155-183
Correspondence regarding this article may be directed to: Katrine S. Bunagan,
Department of Psychology, Ateneo de Manila University, Quezon City. Email:
kbunagan@ateneo.edu
Engaging the Family in Recovery:
Outcomes of a Community-Based
Family Intervention
Katrine S. Bunagan
Chantal Ellis S. Tabo
Ateneo de Manila University
Violeta V. Bautista
University of the Philippines
Maria Isabel E. Melgar
Trixia Anne C. Co
Maria Regina H. Hechanova
Ateneo de Manila University

Family in a Drug recovery intervention
156
Studies on drug use and family factors found that families dealing
with drug use often have complex dynamics and that the relationship
between drug and family dynamics appears to be bidirectional
(Hosseinbor, Bakhshani, & Shakiba, 2012). Literature shows that
parenting styles impact onset and course of drug use in minors (Gruber
& Taylor, 2006). Having drug-abusing parents affected children’s
outcomes. Likewise, patterns of neglectful or inconsistent parenting
result in less favorable outcomes for children, especially those raised
in so called substance use disorder (SUD) families (Lander, Howsare,
& Byrne, 2013).
Even as family factors are associated with drug use, the family
is also a significant contributor to recovery capital. Family plays an
important role in drug recovery and intervention (Coleman & Davis,
1978; Stanton & Shadish, 1997; Velleman, Templeton, & Copello,
2005). Research shows that interventions that include the family have a
higher chance of success than interventions without addressing family
problems (Stanton & Shadish, 1997). Family support is an important
contributor to drug recovery, so much so that people without family
support are at a disadvantage in formal drug use treatment (Clark,
2001). Many drug users who go through addiction recovery programs
relapse back to drug use because the program has not adequately
addressed the important role of the family (Lavee & Altus, 2001).
Literature on drug recovery in the Philippines is sparse. There is
some literature on the recovery of users (Guabong, Longno, Castro &
Guinto, 2014), predictors of relapse (Tuliao & Liwag, 2011) and effect
of drug use on children (Yusay & Canoy, 2019). However, there is a
dearth on literature on the involvement of families in drug recovery
interventions in the Philippines. This study contributes to the gap
by examining the outcomes of a community-based drug recovery
intervention that includes family members.
Family, Drug Use and Recovery
Contemporary perspectives on drug use recognize that it is a
complex issue with biological, psychological, personality, cognitive,
social, cultural and environmental influences (Skewes & Gonzalez,
2013). Among various influences, the family plays a large role both in

Bunagan, TaBo, BauTisTa, Melgar, Co, & HeCHanova 157
the use and recovery of a person who uses drugs (PWUDs).
Research suggests family-related factors that may influence drug
use. Factors such as maladaptive interaction patterns, poor family
management, weak family ties, dysfunctional authority structures,
and family history of drug use have been identified as among the
contributory factors to drug addiction for adults and adolescents
(Hawkins, Catalano, & Miller, 1992; Jêdrzejczak, 2005; Szapocnik et
al., 1989 ).
However, the family can also be a source of recovery capital
among PWUDs. Studies show that when relationship in the family is
more encouraging and supportive, individuals have healthier coping
mechanisms in the face of challenges (Goldenberg & Goldenberg,
2013). Thus, mobilizing the resources of the family enhances the
effectiveness of a drug recovery program (Clark, 2001; Stanton &
Shadish, 1997; Velleman et al., 2005).
The recognition of the important role family plays in recovery
suggests the need to involve them and there is robust evidence that
interventions involving the family are more effective in reducing
drug use than those that do not (Lewis, Piercy, Sprenkle, & Trepper,
1990; Stanton & Shadish, 1997). The literature on psychotherapy for
SUD is replete with studies that show how family therapy using the
systems approach is more effective in facilitating drug recovery and
preventing relapse (Daley, 2013; Goldenberg & Goldenberg, 2013;
Larner, 2004; Stanton & Shadish, 1997). Systemic therapy aims to
cultivate family support and functioning by addressing past, present,
and future relationships within the family with the goal of changing
family functioning (Goldenberg & Goldenberg, 2013; Larner, 2004).
Community Based Mental Health Interventions in the
Philippines
Much of the literature on family interventions has been in the
context of family psychotherapy. However, recent years have seen a
rise in outpatient and community-based programs for drug use. In
community-based programs, community workers reach out to families
and families, in turn, become more involved as well in the community
(Carter & McGoldrick, 1999). An integrated family and community

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program has been shown to play a role in maximizing the effectiveness
of prevention and recovery programs for individuals with SUDs. In
particular, utilizing community workers is an innovative and cost-
effective means to deliver mental health programs and interventions
for individuals and their families. This approach is considered as one
of the best practices to address mental health in large-scale programs
(Rebello, Marques, Gureje, & Pike, 2014; Vaughan, Kok, Witter, &
Dieleman, 2015).
The use of community-based family interventions in the
Philippines is still in its infancy. A study on Katatagan, a group-
based resilience intervention for Filipino disaster survivors, reports
significant improvements in anxiety and resilience compared to
those who did not go through the program (Hechanova, Waelde, &
Ramos, 2016). Parr (2015) documented the use of expressive arts in
a family intervention delivered to families in Tacloban who survived
Typhoon Haiyan. A family intervention entitled Masayang Pamilya,
was also developed and pilot-tested among low-income recipients of
the conditional cash transfer program of the Department of Social
Work and Development. The program tackles emotions, mindfulness
techniques, collaborative problem-solving and parenting experiences
within small groups to improve well-being and prevent child-
maltreatment (Alampay et al., 2018).
Development of KKDK and its Family Support Component
To date, there has been no documented community-based drug
treatment program where families are active participants in the
intervention. This is unfortunate because a needs analysis conducted
among PWUDs and their families highlight the critical role of family.
Interviews revealed the existence of a number of family-related issues
including drug use in the family, family problems and separation,
parental neglect and abuse, dysfunctional parenting, etc. At the same
time, family members did not have knowledge on the effects and
symptoms of drug use and how to help their family members (PAP,
2017). Beyond family issues, the needs analysis highlighted the lack of
knowledge among PWUDs on how to manage their cravings, triggers
to avoid, and how to avoid relapse. At the same time, drug use was a

maladaptive way of coping with their many problems. They reported
that their drug use led to more problems in their family such as conflict
and separation (Hechanova et al., 2018).
The Katatagan Kontra Droga sa Komunidad (KKDK) was
designed to address the psychosocial needs of mild-risk users. The
KKDK intervention consisted of 12 individual modules that focused
on skills for recovery (motivation to change, managing cravings,
managing triggers, refusal skills, healthy lifestyle) as well as life skills
(managing negative emotions, interpersonal skills, problem-solving,
stress management). These modules were designed to be culturally
appropriate to the Philippine context, but used as its foundation
principles of motivational interviewing, cognitive behavioral therapy,
and mindfulness (for more information on KKDK, see Hechanova et
al., 2019).
The families were engaged in the treatment in two ways. The
first was through the homework embedded in individual modules
that required participants to involve their family members. Some
examples of assignments included asking family members about the
effects of their drug use on them, finding out how important it is to
family members that participants change their drug use behaviors,
discussing with family members factors that triggers use, and asking
for forgiveness for hurts they may have caused, etc.
Beyond engaging the family in the homework, three family
intervention modules were developed. The family modules used
family systems as a framework that emphasizes the importance of
understanding dynamics within the family to facilitate changes that
could support clients in their drug recovery journey. The modules
aimed to facilitate communication among family members about (i)
the nature of the relative’s drug use; (ii) how the drug use is affecting
the family; (iii) specific aspects of family relationship that contribute
to drug use; (iv) support from the family to the drug user; and (v) useful
strategies in dealing with identified family-related problems. The
development of modules were guided by the systemic family therapy
theory and by family addictions recovery programs in the context of a
residential treatment facility (PAP, 2017).

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The first KKDK Family module is Paglilinaw at Pag-unawa sa
Problemang Dulot ng Adiksyon (Knowing and Understanding the
Problems Brought by Addiction). In this module, only the family
members are present, not the drug user. This module allows the
participants to share their thoughts and feelings about the family
member who uses drugs, and addresses misconceptions by clarifying
what addiction does to a person. Part of the aim is to help family
members reflect on the effect of drugs on the family and the roots of
addiction. This module takes approximately 2 hours and 30 minutes
to complete (PAP, 2017).
The second module is Pagharap sa Ugat ng Adiksyon (Facing
the Root of Addiction), where both family members and drug users
are required to attend. This module facilitates dialogue between
the parties as each member is given an opportunity to share their
experiences vis-a-vis drug addiction. It also aims to address the root of
the problem by determining what triggered the start of the drug use.
It provides an opportunity for the family to open communication lines
regarding drug use and move them towards the planning phase in the
next module. This module takes approximately 3 hours and 5 minutes
to complete (PAP, 2017).
Finally, the third module is Paghakbang sa Pamilyang
Bumabangon (Moving Forward as a Family in Recovery). Based on
what they learned about the roots of addiction from the previous
modules, participants and family members are asked to make plans
for recovery and change in both individual and family functioning to
support recovery. This module takes approximately 3 hours and 10
minutes to complete.
KKDK was pilot-tested and initial evaluations revealed significant
improvements in recovery skills, life skills, and psychological well-
being of participants. An analysis of posttest scores also revealed
a negative correlation between life skills and SUD symptoms and a
positive relationship between recovery skills and psychological well-
being (Hechanova et al., 2019). However, the aforementioned study did
not report any outcomes related to the family. This study complements
the study of Hechanova et al. (2019) by highlighting the outcomes of
the KKDK interventions on the family of participants.

Research Question
This study examined the outcomes of the KKDK interventions on
the families of participants. Given the goal of systemic therapy to build
family support and enhance functioning by improving relationships
within the family (Goldenberg & Goldenberg, 2013; Larner, 2004),
it was expected that enhancing recovery and life skills would enable
greater family support and, subsequently, improve family functioning.
More specifically, the study sought to answer the following
questions:
1) What are the perceived changes in participants and family
relationships as a result of the program?
2) Can the program enhance perceived family support and family
functioning?
3) What is the relationship between family support and family
functioning and SUD symptoms at the end of the program?
METHOD
Design
This study utilized a mixed method design to gain a better
understanding of the outcomes of the program on the participants
and their families. This triangulation design uses quantitative and
qualitative data simultaneously to use one form of evidence to
complement the other and thus obtain a clearer understanding of the
developing experiences within participating families.
A pretest-posttest design for the quantitative evaluation of the
KKDK family modules was conducted. Post-program evaluation was
also done qualitatively using semistructured interviews with family
members who participated in the program.
Setting
Seven communities in two Metro Manila cities were tapped for the
study. The KKDK program for individual modules and family modules
were conducted by trained community workers in barangay halls (for

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individual modules) and a school hall (for family modules).
Sample
Participants in two Metro Manila cities were identified in
coordination with their respective City Vice Mayor’s Office. The
barangay captains and their corresponding precincts helped with the
identification and recruitment of participants. The sample is composed
of a random mix of male, female, and LGBTQ participants. Many had
undergone other community-based interventions that tapped into
livelihood (BANAT) and spirituality (SIPAG and Sanlakbay) aspects
of addictions recovery work. BANAT provides opportunities for work,
while SIPAG and Sanlakbay are programs focused on prayer and
developing spirituality towards recovery.
Participants in the family modules were family relatives of drug
users who participated in the KKDK modules. Family members
included parents, siblings, spouses, children, relatives or close friends.
The number of family members attending for each participant varied.
A total of 107 KKDK participants who joined the family modules
participatedinthesurveywhile19familyparticipantswereinterviewed.
The age range of the family members who attended are from 16 to 75
years. Majority of them were wives, children, and husbands of the
KKDK participants. A small number were parents, siblings, and close
friends.
Family interviewees were selected through convenience and
purposive sampling for an individualized face-to-face interview by
the research team. Interviewees met the inclusion criteria that they
had to be family members of KKDK participants who finished the
program, attended the family modules, and at least 16 years old. Of
the 19 participants, nine were children of participants (four daughters
and two sons), eight were wives, one sister, and one mother. Their ages
ranged from 16 to 75 years.
Measures
Interview guide. For the qualitative aspect, a semistructured
interview guide was conducted in Filipino for collecting data with

the family members who attended the KKDK family modules. The
interview included questions about how family members view the
family modules that they attended, and what changes they saw in their
family after the program. The main questions were: “How do you view
the KKDK program?” and “How did undergoing the program affect
you/your family?”
Family support. This measures how an individual perceives
social support from their family. This study used the Filipino translated
Multidimensional Scale of Perceived Social Support by Zimet, Dahlem,
Zimet, and Farley (1988). Items were rated on a 7-point Likert scale
where 7 is Very Strongly Agree and 1 is Very Strongly Disagree.
As the measure is part of a battery of tests for the drug user, the
researchers only included the items from the family factor. A sample
item is “I can talk about my problems with my family.” The test had
Cronbach’s alphas of .88 at pretest and .87 at posttest, indicating
internal consistency.
Family functioning. This study used the Filipino translated
GF12 (General Functioning) subscale of the Family Assessment
Device (FAD) by Epstein, Baldwin, and Bishop (1983) to measure
family functioning. Based on McMaster’s model of family functioning
(Epstein, Bishop, & Levine, 1978), it measures six dimensions of family
life. For this study, only the 12-item scale that measures the family’s
general functioning was utilized (Boterhoven de Haan, Hafekost,
Lawrence, Sawyer, & Zubrick, 2015; Turliuc, Ciudin, & Roby, 2016). It
has a 4-point Likert scale, such that the higher the score, the more they
perceive their family as problematic. Sample items include “Planning
family activities is difficult because we misunderstand each other” and
“There are a lot of bad feelings in the family.” The GF subscale had
adequate internal consistency with Cronbach’s alphas of .82 at pretest
and .78 at posttest.
Substance use dependence. This refers to symptoms of SUD
basedonICD-10.ItwasmeasuredusingtheICD-10checklistformental
disorders (psychoactive substance use syndromes module), a self-
report checklist to indicate whether or not they experienced cravings,
withdrawal, harmful effects, etc. Internal consistency reliability was
.67 for pretest and .72 for posttest.

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Procedure
Inviting families. Families of participating drug users were
invited to join the Family Modules sessions. Community facilitators
and barangay coordinators encouraged participants to bring their
families to attend the family modules as part of the KKDK program.
They were instructed to bring at least one family member. Majority of
participants were able to bring a family member to the family modules.
Challenges with attendance include difficulties with finding childcare,
needing to work on the designated schedule, and being estranged from
family members.
Running the family modules. The family modules were
run by trained community workers working side by side with KKDK
facilitators from PAP. The modules were run after the 12 individual
modules. This is to ensure that the drug users already have processed
much of their drug use experience, and has had some time to reflect
on what they want to do in life. In this way, it is expected that they
are more ready to engage their respective families in meaningful
facilitated sharing sessions. The family modules were run once a week
for three weeks.
Administering the surveys. Participants were asked to
complete a pretest prior to the first KKDK module. A posttest
evaluation was also given on the third and last family module. After
the closing ceremony of the module, the participants were requested
to answer the same scale as the survey in the first individual module.
All participants read and signed informed consent forms to participate
in the research.
Interviewing the families. Family participants who were
willing to be interviewed read and filled out informed consent forms
with an overview of the research project. It emphasized that their
involvement in the research was voluntary. They were also given a short
briefing that discussed that the research project is an independent
endeavor of the PAP and that their answers were strictly confidential.
The interview phase occurred a week after all the family modules have
been conducted. These interviews were conducted for about 30-45
minutes per family member. Inclusion criteria for the interviewees
had to be met and informed consent forms read and signed.

Ethical Procedures
Ethical clearance for this study was obtained from the Ateneo de
Manila University research ethics board. Care was made to follow the
principle of informed consent and beneficence. The program promoted
values of respect for rights and dignity of participants, facilitators, and
stakeholders, both in the design and how it was facilitated. Reflexivity
was practiced by the researchers, especially in conducting thematic
analysis of qualitative data, cognizant of potential personal and
institutional biases. Due caution was practiced in interpretation and
interrater consultations were undertaken in coming up with themes.
Consensus for the final categories and sub-categories was obtained.
Data Analysis
Thematic analysis was used to extract the themes from individual
interviews after the last family module. Thematic analysis was used
to examine the data collected from the interviews, narratives, and
records of the participants (Creswell, 2009). The phases of thematic
analysis outlined by Braun and Clarke (2006) were used to process the
data. Phase One involved familiarizing with the data and transcribing
the interviews. Phase Two was for identifying ideas that are potentially
interesting from the data set and an initial set of codes were generated
by three of the researchers. Phase Three involved examination and
clustering of the different codes from Phase Two. Potential themes and
subthemes were culled and discussed in a meeting with the research
team. After reaching a consensus, themes were consolidated and
finalized.
To analyze the pretest-posttest evaluation, a paired samples
t-test was employed using IBM Statistical Package for Social Sciences
(SPSS) version 21 software. This statistical tool helped determine if
there were significant changes in the perceived family support, family
functioning, and SUD symptoms by the former drug users before and
after the family modules. Incomplete data were excluded from the
analysis.

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RESULTS
Changes Observed by Participants and Their Family
Members
Four weeks after the conclusion of the KKDK program, the family
members were interviewed about the changes they have observed
and three themes emerged: being responsible, asserting thoughts and
feelings, and asking for forgiveness/reconciliation.
In the 19 interviews, three themes surfaced frequently regarding
changes in individual characteristics among the former drug users,
as observed by family members. They were perceived as being more
responsible, asserting their thoughts and feelings, and asking for
forgiveness for past transgressions.
Being responsible. Family members shared how they observed
the former drug users to behave more responsibly in performing
their domestic roles. As parents, they showed more involvement
in their children’s school work and obligations. They helped with
the assignments and attended parent-teacher conferences. Their
parenting styles also seemed to change. One father allowed his child
to play outside with the neighbors for a certain time without resorting
to scolding. As partners, the former drug users were also observed to
help more around the house. Partners mentioned how they now cook,
clean the house, and even help with laundry.
Hindi na niya nagagawa. Andyan pa din yung pagkaayos
ng bahay niya. Maasikaso pa rin. Nagluluto. Naglalaba,
tinutulungan na ko maglaba. Dati wala eh. Kahit maglaba ko
dyan, wala eh, tulog siya. [He takes care of things now. He cooks,
does the laundry, helps me now with the laundry. Before, there
was none of that. When I did the laundry, he would just be asleep.]
(Wife)
Related to this, family members also observed how their family
members seemed to have shifted their attitude towards money.
Before the program, they had little to no savings because the money
they earned was spent on vices. After going through the program, the
family members shared how the recovering drug users saved money

for the family, such as for children’s allowance and more important
expenditures. They also refrained from asking money from their
partners.
Ngayon? Ayun, ano lang siya tutok na siya sa ano, sa pagda-
drive niya. Tapos pati baon ko nagbibigay na niya ng sapat,
hindi katulad ng dati na hindi na ako madalas nabibigyan ng
baon. [Now, he is focused on his driving. He is also able to give
me adequate allowance. Unlike before, he often could not give me
any allowance.] (Child)
Asserting thoughts and feelings. Some improvements in
the interpersonal communication style of the former drug users were
also observed. They tended to talk more about their problems without
hesitation. They had more effective ways of talking to each other,
even when they would argue. Family members also learned how to
communicate effectively. They were firmer with their beliefs and less
afraid to fight for what they think is right.
Oo nakokontrol niya yung bibig niya ngayon dati palaaway
si ate. Panganay namin yan tas dalawang lalaki. Talagang
mabunganga siya noon pag may nakita siyang hindi niya
kagustuhan tatatatatatata ganyan na yung bibig niya ngayon
nakakapag control kahit papano natuto narin siya makinig sa
nanay namin. [She is now able to control the things that she says.
She used to always pick fights. She is our eldest, then our two
brothers. She used to be loudmouthed when she sees something
she does not like. Now she is able to control what comes out of her
mouth, she has learned to listen to our mother.] (Sister)
The former drug users were also observed to be more able to
express their love, as the family members observed that they are
more affectionate. They openly said, “I love you,” and showed signs of
affection more frequently than before. They were also more likely to
admit their shortcomings and take actions to change.
Tapos yung mga bagay na simple lang na syempre po bilang
asawa natutuwa ako. Yung bang kahit- sabihin niya “I love you.”
Yung bago matulog po na sa- dati hindi niya ginagawa sakin.
Opo, totoo po yan. Kahit po itanong niyo sa kanya. Talagang

168
malaking-malaki pinagbago niya. [Those simple things that
make a wife happy. Even just him saying, “I love you.” Before
going to sleep… he did not used to do that before. What I’m saying
is true, ask him. He really changed so much.] (Wife)
Asking for forgiveness/reconciliation. Recovering users
also reportedly showed remorse over their past problematic behaviors
and asked for forgiveness, which was very much appreciated by their
family members. The drug users’ relationships with their relatives
improved particularly when the latter noticed positive changes in their
behavior. Mutual trust was identified as a key ingredient in healing
and drug recovery.
Ano, lalo na yung panganay ko, galit siya sa una sa ama niya
dahil nga siyempre nakikita niyang nag-aaway parati, ganun.
Pero nung bandang huli na, yun nga na nagbago na yung ama
niya, napaliwanagan naman ng ama niya, na humingi din ng
sorry, ayun, na ano din ang ano. Mas lalo nga naging close sila
nga ngayon eh. [My eldest, especially, was angry at their father,
because they see us fighting all the time. Later on, their father
changed, he explained things to them, asked for forgiveness,
things got fixed. They are much closer now.] (Wife)
Changes Observed by Participants in Their Family
Relationships
Three themes emerged from the interviews regarding changes
in important aspects of family life as a result of the program. These
changes include improved quality of family life, the family going
through religious rituals together, and spending more time as a family.
Improved family relationships. The family members noted
some changes in the family relationship. They reported feeling closer
with former drug users as they are more able to talk and bond with one
another. This was mentioned by both the partners and children. In one
interview, a child admitted how she could not be proud of her father
(former drug user) before, but that had changed.
Daughter: Tapos ayun po, super ano malapit na po ako kay Papa
tapos, ano kapag wala po akong ginagawa, lumalapit po ako

kay papa, sumasama po ako sa byahe niya, kasi po ayun nga.
Tapos ano po parang gusto ko nang ipagmalaki tatay ko. Ayon
po.
Interviewer: Dati ba hindi?
Daughter: Hindi po talaga eh kasi po ano. Hindi ko po talaga
kaya promise sa mga kaibigan ko hindi ko po kayang ipagmalaki
ang parents ko kasi nga po ganun po yung bisyo nila. Wala po
silang bisyo na sigarilyo, mga alak, pero ayun po talaga eh,
yung drugs. [I am now very close to Papa. When I am not doing
anything, I approach Papa and go with him on duty. Now, I can
be proud of my father. I was not able to do that before. With my
friends, I could not be proud of my parents because of their vices.
They did not smoke or drink, but did drugs.] (Daughter)
Family members likewise learned how to understand the former
drug users. They shared how they were more open with one another.
One daughter shared how she felt happy and hopeful that they could
better face challenges as a family.
Ano, nag open na kami sa isa’t-isa. Tapos ayun ang saya po
namin kumakain, sama sama, tapos yung dati na pagsubok
ngayon kinakaya namin, nang parents po namin ng family po
namin. [We have opened up to each other. We are so happy eating
together. Even trials that we go through can be ably tackled, by
our parents, by our family.] (Daughter)
Interviewer: Ikaw personal ba na relationship mo sa tatay mo,
dati ba close kayo?
Daughter: Hindi po medyo, pero ngayon po, sobrang close po.
Interviewer: Tinutulungan ka na rin sa school? Hinahatid ka
niya?
Daughter: Opo. Yung ano po, kapag may meeting siya na po
pumupunta hindi na si mama. [We were not that close before, but
now, we are very close. He is the one who goes to school meetings
now, instead of my mama.] (Daughter)
Religious rituals. Family members noticed how the former
drug users in their family became more religious. There were even

170
some former users who encouraged their family members to attend
Sunday masses together.
Opo, sobra po ng ibang iba. Kasi po dati talagang parang hindi
po kami makakapag simba tapos hindi po makakakain ng sabay-
sabay parang may sarili po kaming mundo. Tapos ngayon po,
ngayong pasko nagawa po namin ang gusto naming gawin. [He
is very different now. We were not able to go to mass together
before, as if existing in a different world. Now, this Christmas, we
are able to do the things we want.] (Daughter)
The family also prays more regularly than before. Some wives
shared how it is the husband (former drug user) who asks if she already
prayed, which was not how it was before.
Mas ano pa siya ngayon sa’kin. Mas ano siya sa espiritual
ngayon. Kinakayag niya pa ko. “Simba tayo pag Linggo,” sabi
niya. Siya pa nagpapa-alala po sakin. Tas bago matulog sabi
niya sakin, “Nagdasal ka na ba?” Yung mga ganon po. Ganon
siya ngayon. [He is now more spiritual than I am. He tells me,
“Let’s go to mass on Sundays.” He is the one who reminds me.
Before going to sleep, he asks, “Have you prayed?” That’s how he
is now.] (Wife)
More time as a family. Family members shared how the former
drug users chose to spend more time with them family compared
to their usual group of friends. They recounted that even during
Christmas and New Year, they had a happier experience because the
family was complete. They also noted how the former drug users were
choosing to spend their Sunday as family day, such as going to mass
together and going to certain places afterwards.
Masaya, lalo na yung bago lahat nandun ngayon, sama sama
po. Dati po kasi pagbabagong taon kami hindi po. Iba po kasi
si papa noon yung mga taong gumagamit pa po siya. Madalas
mag-away sila ni Mama noong Bagong Taon, pero ngayon hindi
na. [Happy, especially being together. We did not use to spend the
new year together. Papa was a different person when he was still
using. He constantly had fights with Mama on New Year’s. But
now, not anymore.] (Daughter)

Furthermore, they shared about how former drug users also
insisted on eating dinner together as a family, compared to before
when their free time was almost always spent outside the home.
Dati ho talaga, pagka-abot niya ng pera...tambay na yan sa
labas…Ngayon pag dumating sa bahay, kakain kami sabay-
sabay…Kahit na alas-singko palangm nasa loob nalang po siya
ng bahay, nanunuod nalang siya ng tv. Hindi na po siya umaalis.
[Before he would just hand me money and then leave and stay
outside. Now, we eat together. These days, even if it is still five pm,
he just stays at home and watches TV. He does not leave anymore.]
Changes in Family Functioning, Perceived Family Support,
and SUD Symptoms
Participants who went through the KKDK program reported
significant improvements in family support and family functioning.
They also had significant decrease in SUD symptoms before and after
the program. Table 1 shows a summary of changes in these variables
from pretest to posttest.
Family functioning items covered different areas such as
acceptance, communication, and decision-making. Significant
differences were evident in family functioning items particularly in
acceptance (Item 4, t=3.44) and communication (Item 3, t=2.13).
Though one of the three decision-making items (Item 9) and
Family Functioning
Perceived Social Support
SUD Symptoms
Table 1. Summary of Family Functioning, Family Support,
and SUD Symptoms
Pretest
M (SD)
2.96 (0.52)
6.39 (0.78)
0.39 (0.71)
Posttest
M (SD)
3.29 (0.48)
6.67 (0.59)
0.30 (0.75)
t
4.5
3.0
1.3
df
91
91
91
p
.04
.03
.19

172
communication items (Item 5) did not show a significant difference
in their mean scores, other items showed a difference in the paired
samples t-test. Overall, results showed a general improvement in
family functioning before and after the program, as shown in Table 2.
Participants reported an increase in family support after
completing the program. All items had a higher mean score in the
posttest than the pretest scores. Statistically, the difference between
Items 1 (t=2.19) and 2 (t=2.33) in the pretest and posttests were
significant at α = 0.05 level. The difference between item 3 (t=4.06) in
the pretest and posttest on the other hand was significant at α = 0.01
level. Participants report that their families strive to help them (Item
1), that they receive family support and emotional help (Item 2), and
they are able to discuss problems with their family (Item 3). These
changes in perceived family support are shown in Table 3.
SUD symptoms, especially experiences of cravings, withdrawal
symptoms, and persistent use of substance despite harmful
consequences, showed significant decline after participating in the
program. Table 4 contains the items that look into SUD symptoms
and changes in the experience of symptoms during the course of the
program.
DISCUSSION
Significant changes emerged in family functioning, perceived
social support, and SUD symptoms in the KKDK participants. These
changes appear consistent with the qualitative changes observed by
family members in both the participants and their families. Family
support, in particular, seemed to have a significant effect on reducing
SUD symptoms, as shown in Table 5.
Our first research question was what changes were observed by
family members. Results revealed changes in the person as well as in
the family. Family members noticed changes in the KKDK participant
after going through the individual and family modules, particularly in
terms of becoming more responsible, ability to assert thoughts and
feelings, and asking for forgiveness. Changes in the family were also
observed, such as improving family relations, engaging in religious
rituals, and spending more time as a family. This is consistent with

Table
2.
Mean
Differences,
Standard
Deviation,
T-test,
and
Correlation
of
Family
Functioning
Item
1.
Planning
family
activities
is
difficult
because
we
misunderstand
each
other.
2.
In
time
of
crisis,
we
can
turn
to
each
other
for
support.
3.
We
cannot
talk
to
each
other
about
sadness
we
feel.
4.
Individuals
are
accepted
for
what
they
are.
5.
We
avoid
discussing
our
fears
and
concerns.
6.
We
can
express
feelings
to
each
other.
7.
There
are
lots
of
bad
feelings
in
the
family.
8.
We
feel
accepted
for
what
we
are.
9.
Making
decisions
is
a
problem
for
our
family.
10.
We
are
able
to
make
decisions
about
how
to
solve
problems.
11.
We
don’t
get
along
well
together.
12.
We
confide
in
each
other.
M
2.74
1.45
2.57
1.47
2.88
1.76
2.28
1.79
2.66
1.54
2.09
1.73
SD
1.03
0.69
1.05
0.79
0.96
0.93
1.12
0.93
1.13
0.80
1.10
0.91
M
3.01
1.23
2.87
1.25
1.76
1.26
2.74
1.21
2.89
1.23
2.51
1.31
SD
1.00
0.55
1.02
0.53
0.45
0.44
1.14
0.41
1.08
0.46
1.19
0.47
Pretest
t
1.71
2.64
1.85
2.16
12.3
4.11
2.66
4.52
1.27
2.99
2.28
4.16
Posttest
df
69
70
69
68
69
68
70
69
70
68
70
70
p
.09
.01
.07
.04
.00
.00
.01
.00
.21
.00
.03
.00

174
Table
3.
Mean,
Standard
Deviation,
T-test,
and
paired
correlations
of
Perceived
Family
Support
Item
1.
My
family
really
tries
to
help
me
2.
I
get
the
emotional
help
and
support
I
need
from
my
family
3.
I
can
talk
about
my
problems
with
my
family
4.
My
family
is
willing
to
help
me
make
decisions
M
6.46
6.37
6.29
6.51
SD
1.00
0.98
0.84
0.68
M
6.73
6.65
6.74
6.69
SD
0.70
0.83
0.47
0.83
Pretest
Posttest
t
2.19
2.33
4.06
1.89
df
70
70
69
69
p
.03
.02
.00
.06

Table
4.
Mean,
Standard
Deviation,
T-test,
and
Paired
Correlations
of
SUD
Symptoms
Item
1.
Did
you
have
a
strong
desire
or
sense
of
compulsion
to
use
substance?
2.
Did
you
find
it
difficult
or
impossible
to
control
your
use
of
substance?
3.
Did
you
experience
withdrawal
symptoms
after
going
without
substance
for
a
while?
4.
Did
you
use
substance
to
relieve
or
avoid
withdrawal
symptoms?
5.
Did
you
notice
that
you
required
more
substance
to
achieve
the
same
physical
or
mental
effects?
6.
Over
time,
did
you
tend
not
to
vary
your
pattern
of
use
of
substance?
7.
Did
you
increasingly
neglect
other
pleasures
or
interests
in
favor
of
using
substance?
8.
Did
you
persist
with
using
substance,
despite
clear
evidence
of
harmful
consequences?
9.
Did
you
persist
with
using
substance,
despite
clear
evidence
of
harmful
consequences?
M
0.30
0.04
0.10
0.00
0.01
0.03
0.08
0.01
0.00
SD
0.17
0.20
0.30
0.00
0.12
0.17
0.28
0.30
0.00
SE
.02
.02
.04
.00
.01
.02
.03
.04
.00
t
5.75
0.45
2.30
0.00
0.00
1.43
5.75
1.14
1.00
df
70
70
70
70
70
69
70
70
69
p
.57
.66
.02
-
1.00
.16
.57
.26
.32

176
1)
Prefamily
Functioning
2)
Postfamily
Functioning
3)
Prefamily
Support
4)
Postfamily
Support
5)
Pre-SUD
6)
Post-SUD
Table
5.
Correlations
of
Family
Functioning,
Family
Support,
and
SUD
Symptoms
1
--
.16
.45**
.47**
-.21*
-.27*
2
--
.11
.08
.09
.00
3
--
.35**
-.25**
-.01
**p
<
.01,
*p
<.05.
4
--
.06
-.30**
5
--
-.06
6
--

the literature that found more favorable outcomes after engaging
in family interventions for substance and alcohol use disorders
(Copello, Velleman, & Templeton, 2005; Stanton & Shadish, 1997).
In relation to the second research question, perceived family
support and family functioning were enhanced after participating in
the family intervention, as shown in the qualitative and quantitative
data. This is consistent with findings from the literature on family-
based interventions that show improvements in family functioning
(Rowe, 2012).
The third research question looked into the changes in perceived
family support and family functioning and how these changes
correspond to decreases in SUD symptoms as participants go
through and finish the KKDK individual and family modules. Results
highlighted the importance of families taking time out to listen to
what their relative has gone through and exploring ways to help the
recovering user. This made users feel that their families cared for
them, rather than rejecting or blaming them. This validates literature
that the sense of being supported by the family can facilitate recovery
from drug use (Rowe, 2012).
An important change was the increased time together as a family.
This is important especially in view of the fact that long hours of
work is increasingly becoming a way of life among Filipinos (Edralin,
2012). Interestingly, the modules were perceived by family members
to be linked to observed changes in the quality of interactions within
the family. Changes in family well-being has been identified in the
literature as a salient factor that protects a person from continuing
with drug use (Ibrahim & Kumar, 2009; Velleman, Templeton, &
Copello, 2005).
Given the religious nature of the Filipino psyche (Miralao, 1997),
it is not surprising that family members manifest more healthy family
relationships in the form of togetherness in religious rituals. This
augurs well for drug users. Studies have recognized the role of religion
and spirituality in helping Filipinos survive against the odds, as in the
case of survivors of Typhoon Yolanda (Almazan et al., 2018) and drug
dependents (Hechanova et al., 2018).
The finding that sense of family support is not significantly
experienced by former drug users in the area of decision making bears

178
some reflection. Since drug use is associated with weakness in life
skills such as decision making (Bechara, 2005; Grant, Contoreggi, &
London, 2000), helping families of recovering drug users to engage in
issues related to making decisions can further enhance their positive
influence on their relatives’ recovery process.
The particular link found between family support and reduction
of SUD symptoms finds support in the literature (Daley, 2013).
Engaging the family in the recovery process appears to be beneficial as
families are given the opportunity to address the situation as a family
and provide support towards recovery. Overall, the study shows how
families of individuals in drug recovery are important resources to
enhance recovery capital and lead to more favorable outcomes. They
may have been part of the problem that led to drug use, but they are
also a significant part of the solution.
Recommendations for Research and Practice
The study has limitations in terms of generalizability and scope.
The study was a nonexperimental study which limits inferences of
causality. Further investigation may be needed to evaluate family
interventions using more stringent research designs to control for
confounding variables. Convenience and purposive sampling were
utilized,whichlimitsgeneralizability.Theconditionsinthecommunity,
such as availability of potential participants and safety concerns were
some barriers to data collection. The data from the interviews came
from different perspectives of different family members. Future
studies may wish to focus on a specific type of family member, such as
the spouse or child of the participant.
Drug use and recovery is currently a controversial area for
research and practice. The study is embedded within the bigger KKDK
research project engaged in assisting LGUs with implementation of
their community-based drug recovery program. These endeavors pose
inherent and emerging challenges, related to politics, safety concerns,
and other ethical considerations.
To further clarify aspects of the family sessions that are helpful
to generating a sense of being supported and bringing about changes
in quality of family interaction and capacity to resist relapsing into

drug use, succeeding KKDK family sessions should make space for
interviews with family members and the drug users themselves with
regards to what aspects of their experience in the family workshops are
most helpful in bringing about noted changes in the study.
The study points to the importance of culture in identifying
protective and hindering factors to relapse of recovering relatives.
Spiritualityandrecoveryisanareaofresearchthatcallsforcloserstudy.
The challenge of helping families support their recovering relatives to
deal with issues related to decision making without violating personal
boundaries and encouraging enmeshment also needs closer attention.
The study only focused on data immediately after the program. A
basic challenge is how to sustain the initial changes that were observed
through this program. The family modules did not promise healing
to occur immediately even as they were guided on how to plan for
ways to achieve their family goals. A follow-through study after six
to 12 months is suggested to identify recovering users’ progress and
setbacks.
An aftercare family intervention and counseling program should
ideally be in place to support the continuing or evolving needs of
affected families. Since local resources are limited, a peer counseling
program in the community could be an option. This means informal
support may be extended by neighbors or support activities may be
initiated by an association of recovering KKDK alumni. The outcome
of the KKDK is certainly empowering among families because of the
experience of positive changes as well as new knowledge and skills that
were acquired. The engagement of these families in future programs
assures better success in spite of challenges such as availability and
scheduling, because they have felt and seen the immediate outcomes
of this intervention.
AUTHORS’ NOTES
This study was funded by the Commission on Higher Education
K-12 Dare to Research Grant.

180
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